In his ruling, Judge Joseph Johnston found that there is “credible psychiatric and medical evidence” to suggest that Justina suffers from a “persistent and severe Somatic Symptom Disorder” rather than the mitochondrial disease with which she was initially diagnosed and heavily criticized her parents, saying she needs to remain in state custody “due to the conduct and inability of her parents, Linda Pelletier and Lou Pelletier, to provide for Justina’s necessary and proper physical, mental, and emotional development.”

Johnston asserted that the Pelletiers had repeatedly abused medical staff as well as those working for the Massachusetts Department of Children and Families and twice undermined efforts to transfer Justina to different facilities by threatening to sue one and generating protests by Religious Right activists outside of another, which resulted in both facilities ultimately declining to take her.

In addition, Johnston denied Mat Staver’s efforts to sign on as the parents’ legal counsel.

Based on the recommendations of both the Massachusetts Department of Children and Families and the Connecticut Department of Children and Families, as well as the Guardian ad litem assigned to act in Justina’s best interest, Johnston ruled that Justina would remain in state custody:

The judge’s four-page decision, which was provided to the Globe, was remarkable for its detail and forcefulness. Johnston faulted Connecticut’s child protection agency for its failure to get involved in a case involving a child from its state, and faulted Pelletier’s parents for their verbally abusive manner and haphazard decision-making that he says has sabotaged plans to move their daughter closer to home.

Johnston wrote that the parents called Boston Children’s Hospital personnel Nazis “and claimed the hospital was punishing and killing Justina. Efforts by hospital clinicians to work with the parents were futile and never went anywhere.”

More recently, he wrote, “there has not been any progress by the parents. Rather, the parents . . . continue to engage in very concerning conduct that does not give this court any confidence they will comply with conditions of custody.” He noted that because of allegations that Justina’s father, Lou Pelletier, threatened a state social worker assigned to the case, the worker had to be reassigned.

In his ruling, Johnston, for the first time publicly, stated his belief that Pelletier suffers from “a persistent and severe Somatic Symptom Disorder,” a psychiatric diagnosis that doctors at Children’s reached in early 2013 when the girl was brought there because she had difficulty walking and eating. The parents objected to that diagnosis, leading to accusations of medical child abuse and setting off a monthslong battle over her care.

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Johnston also denied a request by lawyer Mathew Staver of Liberty Counsel in Florida to help represent the parents. Staver said he plans to take part in a plan to appeal Tuesday’s ruling on legal grounds, a process that he hopes might reverse the custody decision earlier than the summer.

In tone, Johnston’s ruling made it appear he had lost patience after trying for months to carefully orchestrate a resolution to a case that has drawn nationwide media attention.

Lou Pelletier has taken part in numerous national media interviews to condemn the Department of Children and Families and the judge and call for the return of his daughter. Since the start of the year, several conservative Christian organizations have gotten involved in defending the parents, seeing the case as an example of government interference in the sanctity of parental rights, and have instigated massive phone and letter-writing campaigns to the judge and other state officials.

Johnston wrote that the parents had repeatedly “impeded progress” in resolving the case. “Instead of engaging in quality visits with Justina, the parents use profanity directed at MA DCF personnel in Justina’s presence,” he said. “There is absolutely no meaningful dialogue by the parents to work towards reunification.”

Staver, for his part, has vowed to “pursue every legal means,” including filing a habeas corpus petition if necessary:

Today, Judge Joseph Johnston ruled that the custody of Justina will remain with Massachusetts DCF until a future hearing, which could not be set any earlier than June 20. “Once again, the court is kicking the can down the road. This is unacceptable,” said Mat Staver, Founder and Chairman of Liberty Counsel.

“DCF has no right to hold Justina like a prisoner. We will pursue every legal means to end this tragedy,” said Staver.

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“In all my years in practice, I have never seen a more barbaric overreach by a state agency,” Staver said. “The family has asked us to pursue every legal means necessary to get their daughter home. Liberty Counsel will file an appeal or a habeas corpus petition,” said Staver.

Keith Mason, president of Personhood USA, said the Free Justina Coalition plans to appeal to Massachusetts Gov. Deval Patrick to step into this matter. He also said that they’re considering a permanent office in Boston to organize outreach efforts.

“We’re looking for thousands of people to gather, not just hundreds,” Mason said.